Future research in health care: Quo vadis?

Zurich, Switzerland, 3 August 2020

As a result of medical research and improving hygiene and nutrition the life expectation and the general health condition of mankind have made spectacular progress in the last 100 years. Thanks to the developments in antibiotherapy and chemotherapy are now able to treat efficaciously most infectious diseases, including tuberculosis and HIV, and to cure many types of cancer, which were before decimating the world’s population. The better understanding of pathophysiological mechanisms has allowed us to design new drugs targeted to treat metabolic disease such diabetes, hypertension and hyperlipidemia, thus reducing cardiovascular complications, as well as immunologically triggered conditions like rheumatism or chronic inflammatory bowel disease. Prevention of disease has also played a major role in reducing morbidity and mortality, like interventions such as vaccination or smoking cessation programmes have already shown. However, people are still dying from heart attacks and strokes (18 million deaths per year worldwide), metastatic cancer (10 million deaths/y), AIDS (700’000 deaths/y) as well as from chronic conditions such as terminal heart or lung insufficiency, renal or liver failure. The actual Covid-19 pandemic, which already killed more than half a million persons worldwide and for which there is still no effective cure, has – again – shown us that we are still far from controlling disease and that there is still a lot to be done.

The recent scientific and technological developments and achievements are now opening the door to a new era in medical research, allying genetic and biomolecular analysis methods to digital innovations, which will certainly have a major impact on how we will manage and transform health care in the future. The actual trends in medical research focus on understanding how individual human cells function and interact with their environment, what is called single-cell analysis. The ability for scientists to determine through which intracellular mechanisms genes are turned on or off in individual cells and to decode how the cells of our immune system attack healthy tissue, will transform our approach of autoimmune disease and help us combat the deadly process of cancer metastasis.

Up to 50% of all current research concerns cancer disease and the latest developments in immunotherapy have show that it is possible to modulate our own natural defense system to destroy cancer cells, by producing special cancer fighting warriors called chimeric antigen receptors, that have already saved many lives of patients with untreatable blood cancers. Finding and fighting the right target allows a more precise, effective treatment of cancer, including the most frequent ones such as breast, colon, ovarian and pancreatic tumors, an this with much less side effects. This is what is commonly called precision oder personalized medicine.

Understanding how cells function is also very important in tissue engineering. This exciting field of research looks at ways of replacing or regenerating human tissues and organs when they are damaged. Until know the only way to treat terminal heart, kidney oder liver failure was organ transplantation. Transplantation however is associated with many problems, including sourcing, waiting lists, tissue rejection and the need for anti-rejection drugs. Some countries do not allow its use for ethical or religious considerations. The alternative is what we call regenerative medicine, this includes new methods ranging from stimulating the body’s ow repair mechanisms to growing tissues and organs in the laboratory. This is the field of research of Prof. Baer (BAERMED), who has managed to extract health liver cells from patients with terminal cirrhosis, let them grow on a matrix in the lab and reimplant them in the same patient therewith restoring liver function and preventing death. Many lives could be saved, mostly in countries with epidemic hepatitis, where liver failure kills millions of persons every year. If this technique was possible with other cells, like for example the islet cells from the pancreas, which produce insulin, you could treat diabetes without drugs and prevent all the cardiovascular complications related to this chronic disease which affects hundreds of millions of persons worldwide.

Similar applications could be used in neurology to treat degenerative diseases, which were until know considered as incurable, like Alzheimer, Parkinson, Multiple sclerosis and even schizophrenia, as well as post traumatic brain or spinal cord injury. Thanks to a new digital technology called BRAIN mapping (the NIH’s Brain Research through Advancing innovative Neurothechnologies) researchers are about to map and understand the pathways and circuits responsible for motor function, vision, memory and also emotion and pain. Once these circuits will be identified, it will be possible to develop new targeted therapies. Chronic pain for example is a serious and costly public health problem affecting millions of people worldwide. The NIH recently launched the Helping to End Addiction Long-term (HEAL) initiative harnessing genomics, neuroscience and structural biology to uncover entirely new targets for treating chronic pain.

To complete the panel of research fields in medicine we should not forget the essential role of new vaccines for preventing not only infectious diseases such als Influenza and – hopefully soon – Covid-19 and HIV, which are going on killing millions throughout the world, but also other viral triggered diseases such as the HPV-induced cervix carcinoma.

Modern medicine is also going through a process of digital transformation. New developments in artificial intelligence, through what is called deep learning, have already found new clinical applications, for example in diagnostic radiology, where computer assisted systems have been developed to detect early stadiums of lung cancer. After being trained with 45,000 patients CT scans the Google algorithm detected 5% more cancer cases and 11% less false positive than a control group of 6 experienced radiologists. Computer assisted robots, like the DA VINCI System, already help surgeons in accomplishing routine surgical procedures. But also daily life can be improved through digitalisation, like we have seen with the development of telemedicine, which allows you to consult your physician online and to get an electronically generated prescription. However, we must not forget that computers will never and should never replace the doctor. Surveys conducted in Switzerland and Europe have shown that patients still request and need a human approach. Digitalisation in medicine should help physicians in their diagnostic approach of disease and help them to find out quicker and safer what the patient is suffering from. The physician will the have more time to explain the issues to the patient and imply him in the therapy programme.

Treatment will also be easier if the diagnoses can be made earlier and in a less invasive manner. Here again biomolecular cell-analysis and digitalisation work hand in hand. One major innovation in cancer diagnosis is the so called liquid biopsy, which will allow to trace up to 25 different types of cancers from a single blood sample. Progress in diagnostic imaging is also important, using artificial intelligence for detection of tumors or 3-D reconstruction of organs such as the heart will allow to be more accurate and less invasive, what will always be a benefit for the patient.

Digital innovations might also help us to solve one of our major actual problems in health care, which is the patient’s compliance to treatment. Even though we might have found out the correct diagnosis and implemented the adequate treatment, many patients are reluctant to taking the prescribed drugs or following our medical recommendations. The actual Covid-19 crisis has shown this as well, just alone concerning the use of preventive measures. Another example: of all hypertensive patients diagnosed (and hypertension is a major killer in the long term) only 50% are treated for their high blood pressure and from those receiving antihypertensive agents, only 50% meet the therapeutical targets recommended by the guidelines. One way to improve compliance is to implicate the patient in the management of his own disease, for example by giving him a major role in the monitoring of is own health data. This is called empowerment and is an excellent way to motivate patients to comply with their treatment. Since most people nowadays own a smart phone or wear a smart wrist watch, why which not use them to record medical data? New applications for smart phones (such as developed by MISANTO) allow patients to manage their own medical records. In the future we could aggregate all these data from millions of patients and make it an anonymous but searchable tool for scientists to create a database for new drug developments, lifestyle studies and more.

In conclusion, there are numerous new fields in medical research, which can and need to be explored in order to make patients health care easier and better, either by preventing disease or diagnosing it at an earlier stage. Treatment regimens need to be simplified, what will be possible if we find out how to repair or regenerate damaged organs and restore physiological conditions. Let us finally use the latest medical knowledge and digital technology to combat deadly infections and cancer.

As said previously, there is still a lot to be done, so let us do it.